‘The opportunities offered by healthcare technology for a healthy start in life could be better utilized’

In the Netherlands, children generally grow up relatively healthy. However, there is an increasing number of children with obesity or behavioral problems, and parents are becoming more uncertain about parenting. Good prevention and care during the first thousand days of life can prevent or alleviate many of these problems.

What can technological innovations mean for a healthy start? And why do we still see so few of them in preventive youth and birth care? Through the ZorgTech innovation program, we spoke with three experts.

"There is increasing scientific evidence for the importance of a healthy start," notes Symone Detmar, head of the Youth Knowledge Program at TNO. By a healthy start, she means the first thousand days of life, including the pregnancy and the month before, known as the preconception phase. "The period just before conception has a significant impact on the rest of the pregnancy and the development of the unborn baby."

The mother's lifestyle plays a significant role in this. "Each lifestyle factor can cause growth disorders, with consequences for later life. Too little folic acid can slow down the development of the baby's nervous system. And too much stress and too little or unbalanced nutrition during pregnancy increase the risk of overweight and cardiovascular disease in the child later in life." In the first two years after birth, malnutrition or incorrect care can cause various physical and mental problems, such as diabetes, depression, or a delay in social and emotional development.

Challenges for a healthy start

"Many different healthcare providers are involved in that short but important period of a thousand days, all with their own ICT systems," Detmar continues. "As a result, expectant and young parents must share their information with each healthcare provider again and again, which takes a lot of time. Meanwhile, the burden on birth and preventive youth care is increasing due to both the growing demand for care and the shortage of doctors and nurses." She also notes that care is becoming increasingly complex. "Especially for vulnerable groups, such as refugees and people with a low socio-economic status, it is a maze. Many families would benefit from better integration of medical and social care."

A better integration of medical and social care would benefit many families

Universal measure for measuring child development

Detmar sees progress in innovations for measuring how a child is doing. "For example, the D-score has recently been developed, where the D stands for Development. This score combines different areas of development, such as cognition, language, motor skills, and social-emotional skills, into one number. The D-score is a universal unit of measurement, like the meter for length and the gram for weight. This makes comparisons between countries and groups of children possible, even if the data has been collected using different measuring instruments." The WHO now recommends the D-score as a universal measure for the development of children up to 4 years old.

Patient monitoring systems

Prof. dr. ir. Maaike Kleinsmann is a Medical Delta professor and industrial designer who is closely involved in the Healthy Start program of the Delft University of Technology, Erasmus MC, and Erasmus University Rotterdam. The program investigates how new technologies can be used to help children grow up more successfully. Kleinsmann also researches Remote Patient Management Platforms, which allow patients and healthcare providers to safely exchange information with each other. "We want to remove the barriers between different healthcare domains," she explains. "A well-designed monitoring system allows healthcare providers to collaborate remotely. Patients need to go to the hospital less often, and doctors can manage their time more efficiently and provide higher-quality care."

Improved organization of maternity care.

Patient monitoring systems offer an opportunity for improved organization of maternity and pregnancy care, according to Kleinsmann. "Many healthcare providers are involved, such as midwives, gynecologists, and neonatologists. They can work more efficiently if they have access to the same information. In addition, a pregnant woman often has to go to the hospital for even minor complications. With good sensor technology and remote monitoring, she can stay at home longer. This reduces stress and relieves pressure on the hospital. Furthermore, a negative trend in the measured data can be detected more quickly. In this way, a patient monitoring system also works preventively."

A well-designed monitoring system enables healthcare providers to collaborate remotely, and the patient needs to go to the hospital less often

Technology as a complement to healthcare providers

Bastiaan Bervoets, as a project coordinator, is involved in the development of the parenting robot FLOo. The robot supports parents in need in raising their children, and thus serves as a complement to healthcare providers. "FLOo provides parents with tips, explanations, and reminders, allowing them to perform more tasks on their own. This can increase their self-confidence and self-reliance, and give healthcare providers more focused time." Bervoets also notes that more and more parents are experiencing stress related to parenting, and that sometimes it is difficult to obtain help. "While good attachment between parent and child is essential in those first thousand days. For parents with little self-confidence, that can be challenging. That feeling of inferiority only grows when they feel judged or unable to perform routine tasks on their own."

Barriers to youth care technology

Despite the large potential health benefits, healthcare technologies are significantly less applied in youth care than in elderly care. Kleinsmann sees the main cause in scale. "The care needs of the elderly are much greater than those of children and pregnant women, and there is less subsidy available for youth and birth care than for adult care. This makes it difficult to make an innovation for a healthy start profitable."

Prevention and acute care balancing act

The developers of FLOo experience in practice how difficult it is to raise funding for a youth care innovation. "The difficulty with many healthcare innovations is that the user is not the payer," explains Bervoets. "We are dependent on subsidies and healthcare organizations for funding. They are part of a complex system. It is particularly difficult to obtain capital for a prevention tool. The organizations really try their best, but are caught in a balancing act with the even greater demand for acute care."

Co-creation takes a lot of time, but it is essential to come up with a product that is useful to the target group

Co-creation with the target group

In addition, the development of youth care innovations takes a lot of time because the target group requires a specific approach. Bervoets: "We are developing FLOo for parents who need extra support. This requires intensive collaboration with the target group and the healthcare organizations to which they are connected, as well as good guidance in research and pilots." Finding parents and organizations willing to participate in pilots is already a significant challenge, say the developers. "Co-creation (the joint creation and development of innovation, ed.) takes a lot of time, but is essential to come up with a product that is useful to the target group."

Solution directions

For the funding issue, closer collaboration with government agencies and knowledge institutions can solve a lot, Bervoets knows from experience. "Thanks to the ZorgTech innovation program, we are working together with the municipality of The Hague. They have a large network of healthcare organizations and insurers, and a lot of knowledge of the financial aspect of healthcare. This has greatly helped us." For a structural solution to the problem, he zooms out more. "Healthcare organizations are doing their best to create more space for youth and prevention solutions, but they are bound by budgets. Ultimately, it is the governments that determine the subsidies and structure of the healthcare system. It would help if they could simplify those structures."

A balanced discussion.

Kleinsmann also looks to the government for a solution. "We need clear laws and regulations on how we can develop and implement healthcare innovations safely and effectively. This will prevent us from getting stuck in ethical debates, while healthcare innovations can prevent life-threatening situations. Good standards for safe application can alleviate ethical concerns and accelerate the implementation of technology in healthcare processes. This way, we can better seize the enormous opportunities of healthcare technology."

The innovation program ZorgTech is made possible by the province of South Holland, TNO, the Rotterdam The Hague Metropolitan Region (MRDH), InnovationQuarter, and Medical Delta; the execution is in the hands of InnovationQuarter, TNO, and Medical Delta.